Page:Tropical Diseases.djvu/466

424 other cereals and in a variety of foodstuffs. It seems probable that the destruction by heat in the process of canning, or otherwise, of this body, called by Funk " vitamine " * — which exercises a curative as well as a protective action may account for the prevalence of ship beriberi in Scandinavian ships, especially in long voyages during which such foods are an unavoidable necessity. In this respect there is a parallelism between beriberi and scurvy.

Morbid anatomy and pathology.— There is very little to be said about the post-mortem appearances in beriberi which is not covered by the accepted descriptions of the lesions of peripheral neuritis. There is a degeneration of the peripheral nerves more especially of their distal ends, and there is secondary atrophic degeneration of muscle, including that of the heart, which may be the subject of an acute fatty degeneration like that of diphtheria. Hamilton Wright has shown that degenerative nerve changes (formerly denied) may be detected in the nerve centres and throughout the implicated neurons, as in other forms of peripheral neuritis. This observer seeks to correlate the early or " acute " phase of the disease with the primary poisoning of the nerve-endings, the latter or " residual " phase with the stage of nerve degeneration. If there is anything peculiar about the post-mortem appearances in beriberi, it arises from the somewhat special implication of the central and peripheral organs of the circulation namely, dilatation of the heart, especially of the right side, and great accumulation of blood in the right heart and in the veins. In addition, there is a marked liability in many cases to serous effusion into the pericardium, pleural cavities, peritoneum, and cellular tissue. This very marked liability to serous effusion, and the tendency to cardiac dilatation, may be said to be more or less distinctive of beriberic as compared with other forms of multiple neuritis. The type of œdema indicates thai it depends especially on vaso-motor disturbances, although cardiac weakness and partial suppression of urine may be contributory elements. (Edema of the lungs also is not uncommon, and has, probably, a pathology similar to that of the connective-tissue œdema. There is no nephritis, The only lesion that might be considered specific in beriberi is the duodenitis, which, according to Hamilton Wright, is invariably present in acute cases during the first three weeks of the disease. The invariableness of this lesion is denied by other observers Daniels, Koch, and Hunter.

Mode of death.— The most practically important point in the pathology of beriberi is that which relates to the modes of death. The paresis and the atrophy